血清白介素-18、基质金属蛋白酶-9水平对重型血友病A急性关节出血的预测价值  

The predictive value of serum interleukin-18 and matrix metalloproteinase-9 levels in severe hemophilia A with acute joint bleeding

作　　者：张艳彬[1] 陈文昆[1] 李颖[1] 张佳 李魁星[1] Zhang Yanbin;Chen Wenkun;Li Ying;Zhang Jia;Li Kuixing(Department of Hematology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院血液内科,北京100730

出　　处：《中国医学前沿杂志（电子版）》2020年第12期59-63,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：中央高校基本科研业务费(33332018013)。

摘　　要：目的探究血清白介素-18(interleukin-18,IL-18)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)水平对重型血友病A急性关节出血的预测价值。方法回顾性分析2017年8月至2020年8月中国医学科学院北京协和医学院北京协和医院收治的115例重型血友病A男性患者的临床资料,依据是否出现急性关节出血将纳入患者分为未出血组(62例)和出血组(53例),另选取50例健康志愿者纳入对照组。比较三组受试者α2纤溶酶抑制剂(α2-antiplasmin,α2-AP)、D-二聚体(D-dimer,D-D)、纤维蛋白降解产物(fibrin degradation product,FDP)、纤溶酶原(plasminogen,PLG)、白细胞计数、血小板计数、血红蛋白、血清乳酸、铁蛋白、IL-18、MMP-9等指标水平,探讨重型血友病A患者急性关节出血的影响因素,并评估其对重型血友病A患者急性关节出血的预测价值。结果三组受试者D-D、FDP、PLG、白细胞计数、铁蛋白、IL-18、MMP-9水平比较差异均有统计学意义(均P<0.05),且均为出血组>未出血组>对照组。治疗3个月后,出血组和未出血组患者血清IL-18、MMP-9水平均显著低于本组治疗前(均P<0.05),但出血组患者血清IL-18、MMP-9水平均显著高于未出血组(均P<0.05)。多因素Logistic分析结果显示,血清IL-18、MMP-9水平均是重型血友病A患者急性关节出血的高危因素(均P<0.05)。受试者操作特征曲线显示血清IL-18和MMP-9水平均可预测重型血友病A患者急性关节出血(均P<0.05),其曲线下面积分别为0.693和0.697,灵敏度分别为79.25%和81.08%,特异度分别为67.94%和68.57%。结论血清IL-18、MMP-9水平与重型血友病A患者急性关节出血密切相关,量化这些指标有助于诊断和识别急性关节出血高风险患者,可能是诊断重型血友病A患者急性关节出血的潜在生物标志物。Objective To explore the predictive value of serum interleukin-18(IL-18)and matrix metalloproteinase-9(MMP-9)levels in severe hemophilia A with acute joint bleeding.Method The clinical data of 115 male patients with severe hemophilia A admitted to Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from August 2017 to August 2020 were retrospectively analyzed.According to whether acute joint bleeding occurred,the patients were divided into non-bleeding group(62 cases)and bleeding group(53 cases),another 50 healthy volunteers were selected into control group.The levels ofα2-antiplasmin(α2-AP),D-dimer(D-D),fibrin degradation product(FDP),plasminogen(PLG),white blood cell count,platelet count,hemoglobin,serum lactic acid,ferritin,IL-18 and MMP-9 in three groups were compared,to explore the influencing factors of acute joint bleeding in patients with severe hemophilia A,and evaluate its predictive value for acute joint bleeding in severe hemophilia A.Result There were statistically significant differences in D-D,FDP,PLG,white blood cell count,ferritin,IL-18,and MMP-9 among the three groups(all P<0.05),and they were all bleeding group>non-bleeding group>control group.After 3 months of treatment,the serum IL-18 and MMP-9 levels in bleeding group and non-bleeding group were significantly lower than those before treatment(all P<0.05),but the serum IL-18 and MMP-9 levels in bleeding group were significantly higher than those in non-bleeding group(all P<0.05).Multivariate logistic analysis showed that serum IL-18 and MMP-9 levels were high risk factors for acute joint bleeding in patients with severe hemophilia A(all P<0.05).The receiver operator characteristic curve shows that serum IL-18 and MMP-9 levels can predict acute joint bleeding in patients with severe hemophilia A(all P<0.05),the area under the curve is 0.693 and 0.697 respectively,the sensitivity is 79.25%and 81.08%respectively,and the specificity is 67.94%and 68.57%respectively.Conclusion Serum IL-18 and

关 键 词：白介素18 基质金属蛋白酶-9 重型血友病A 急性关节出血 

分 类 号：R554.1[医药卫生—血液循环系统疾病]